Drugs to Treat Psoriasis
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Psoriasis Drugs

Understanding psoriasis

With psoriasis, your skin cells grow too quickly. This chronic autoimmune condition causes dry, itchy, scaly, and red patches of skin called psoriasis plaques.

If you have psoriasis, your doctor will recommend drugs to help control the condition. The goals of medication are to clear up plaques and to stop your skin cells from growing too fast.

The two types of psoriasis medications include topical treatments and systemic treatments. Topical treatments are creams, ointments, and gels that you apply directly to your skin. Systemic treatments are oral drugs and injectable medications that work from within your body. Your treatment is based on:

  • how severe your condition is
  • what other health issues you have
  • your preferences
  • the safety and effectiveness of the drugs for you

Still, you may want to explore all of your options. Here are the drugs that help treat psoriasis.

Topical drugs

Topical drugs are usually the first line of treatment for most people with mild to moderate psoriasis. In many cases, they’re also used in combination with another type of treatment. Topical treatments include the following options.

Steroid creams and ointments

These are the most commonly prescribed drugs for treating mild to moderate psoriasis. These low-dose steroid treatments work to keep skin cell production in check. They also soothe your skin to improve your symptoms. Side effects can include cuts or wounds that take longer than normal to heal.

Topical retinoids

Retinoids (such as Tazorac and Avage) are made from vitamin A. They work to normalize DNA activity in your skin cells. This slows the inflammation process and the growth of skin cells and plaques.

Retinoids are not as fast acting as steroid creams and ointments, but they have fewer side effects. However, women who are pregnant or plan to become pregnant should not use retinoids. These drugs carry the risk of birth defects.

Vitamin D analogues

These drugs may be used alone or in combination with other treatments for mild to moderate psoriasis. Vitamin D analogues include calcipotriene (Dovonex) and calcitriol (Rocaltrol). These are man-made forms of vitamin D that slow down skin cell growth.

Anthralin or dritho-scalp

This cream works to normalize DNA activity in your skin cells and to remove scales. This treatment is sometimes used with phototherapy or light therapy, which is controlled exposure to ultraviolet light that may help psoriasis. You should only let this cream stay on your skin for up to 30 minutes. It can irritate and stain your skin if you leave it on too long.

Read more: Light therapy explained »

Coal tar creams or ointments

Coal tar is the oldest treatment for psoriasis. Made from the byproducts of petroleum manufacturing, coal tar products reduce scaling, itching, and inflammation. These drugs are available in prescription and over-the-counter (OTC) forms. High concentrations are available by prescription.

These creams have some downsides, though. Coal tar is messy. It may stain your clothing and bedding. Plus it has a strong, unpleasant odor.

Dandruff shampoos

Used to treat scalp psoriasis, these medicated shampoos are available OTC. Prescription-strength versions are also available from your doctor. These shampoos help treat the flakes that psoriasis causes.

Salicylic acid and lactic acid

Both acids are available in OTC and prescription forms and can be used with other treatments. These drugs promote the sloughing of dead skin cells. In turn, this reduces scaling.

Systemic treatments

Depending on how severe your psoriasis is and other factors, your doctor may recommend oral or injectable drugs. Your doctor may also suggest these medications if topical treatments haven’t worked for you. Many of these drugs have serious side effects, though, so doctors use them as first-line treatments only for difficult types of psoriasis.

Methotrexate

This drug suppresses your immune response, which decreases the production of skin cells. Methotrexate is often prescribed to people with moderate to severe psoriasis. It’s one of the most effective treatments for people with erythrodermic or pustular psoriasis. It may also relieve psoriatic arthritis. This drug is available in oral and injectable forms.

Common side effects can include:

  • loss of appetite
  • fatigue
  • upset stomach

Using this drug for a long time may cause liver damage. It may also decrease your red and white blood cells and platelets. This effect raises your risk of anemia, infections, and bleeding.

Women who are pregnant or plan to become pregnant should not take methotrexate. This is because it may increase the risk of ectopic pregnancy and miscarriage. During treatment and for the first three months after stopping treatment, men who take this drug should also avoid getting a woman pregnant.

Get the info: What is an ectopic pregnancy? »

Cyclosporine

This highly effective immunosuppressant drug comes in oral and injectable forms. It weakens your immune system, so it’s only prescribed to people with severe cases of psoriasis. Most doctors only prescribe cyclosporine for short lengths of time, usually three to six months. This is because the drug can raise your blood pressure. Your doctor will check your blood pressure during treatment.

Oral retinoids

The only approved oral retinoid for the treatment of psoriasis is acitretin (Soriatane). This drug works by reducing the production of skin cells.

Another retinoid is bexarotene. It may be used off-label to treat psoriasis. Off-label drug use means that a drug the FDA approved for one purpose is used for a different purpose that has not been approved. Still, doctors can use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors can use drugs to treat their patients. That means your doctor can prescribe a drug however they think is best for your care.

Read more: About off-label drug use »

Oral retinoids are also sometimes used with light therapy. As with other systemic medications, retinoids may cause major side effects. Your doctor may do blood tests to check your cholesterol levels. High cholesterol is a common problem for people who take oral retinoids. Retinoids can also cause birth defects. Women who are pregnant or plan to become pregnant should not take this medication. In fact, women should stop taking retinoids at least three years before trying to become pregnant.

Hydroxyurea

Hydroxyurea is an oral drug that works to treat psoriasis by slowing down cell replication. It may be combined with light therapy. It isn’t as effective as cyclosporine and methotrexate, but it may be used in people who can’t take those medications.

Side effects can include low levels of red blood cells, white blood cells, and platelets. This effect can lead to anemia, infections, and bleeding. This drug can also cause birth defects and miscarriage. Women who are pregnant or plan to become pregnant should not take this drug.

Immunomodulator drugs (biologics)

Biologics are a newer class of drugs that target your body’s immune response. They work by blocking interactions between immune system cells and inflammatory pathways. This action stops your skin cells from growing too quickly.

These drugs are given by injection or infusion (IV). They are often prescribed to people with moderate to severe psoriasis who have not responded to other treatments. Some biologics have been approved to treat psoriatic arthritis, as well. Biologics may slow or stop joint damage altogether.

What are biologics?
Biologics are target-specific drugs. Unlike other drugs that are derived from plants or chemicals, biologics are made from sugars, proteins, or nucleic acids. They may also be made from human, animal, or microorganism cells and tissues.

These drugs include:

Side effects from biologics can include:

  • infections
  • headaches
  • stomach pain

Keep reading: Biologics for psoriasis »

Thioguanine

This oral medication treats psoriasis by blocking cell replication. Your doctor may prescribe thioguanine when other systemic medications can’t be used. While this drug is not as effective as methotrexate or cyclosporine, it does have fewer side effects. It may still cause birth defects, though. Women who are pregnant or plan to become pregnant should not take thioguanine.

Work with your doctor

If you have psoriasis, your doctor may recommend a topical treatment to ease your symptoms. If that doesn’t work or if you can’t use topical drugs, your doctor may suggest an oral or injectable drug to bring you relief. These systemic drugs are more powerful and may cause more side effects than topical treatments. Talk with your doctor about what’s working and what’s not. Your help with allow your doctor to find the best treatment for your psoriasis.

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